Bringing Modern Medicine to the Mountains: Scientific Medicine
and the Transformation of Health Care in Southern West Virginia,
1880-1910

By Sandra Barney

Volume 55 (1996), pp. 110-126

The transformation of West Virginia during the industrial boom
of the late nineteenth century was a complex process that affected
mountain society on myriad levels. While traditional evaluations of
the period focus on the invasion of outside capital and portrayed
indigenous people as unwilling victims of powerful processes beyond
their control, recent scholarship by such historians as Ronald L.
Lewis, Altina Waller, and Mary Beth Pudup remind us that the
introduction of modern industry and the involvement of the state in
the national marketplace was a phenomenon as enthusiastically
supported by some mountain residents as it was vigorously rejected
by others.1

The diverse reactions exhibited by West Virginia residents to
the introduction of modern institutions may, in part, be explained
by acknowledging the competing interests of the mountain residents.
For commercially ambitious mountaineers, increased involvement in
the national market promised new wealth and the possibility of
expanding their social and economic status. More rural residents,
entrenched in traditional customs, were suspicious of the
metamorphosis of the region, seeing it as an invasion of new
philosophies and expectations that threatened to supplant, and
eventually destroy, their way of life.2

The struggle between proponents of these two views was played
out on a number of stages. For example, in The Americanization
of West Virginia, John Hennen studies the confrontation that
developed as new industrial interests fought to create an
educational system that produced complacent workers.3 In some
public venues, like education and health care, the contest between
the old way and the new was complicated by the extensive benefits
modern skills and knowledge offered. The transformation of medical
practice in the southern mountains of West Virginia during the late
nineteenth and early twentieth centuries demonstrates that
modernization promised mountain people significant fundamental
improvements if they accepted their roles as patients in the new
order. When these benefits alone were insufficient to convince West
Virginians of the advantages of modern life, ambitious physicians
turned to other institutions in an effort to induce the state's
residents to embrace new methods of health care.

Medical care in rural West Virginia during much of the
nineteenth century was frequently primitive and often entirely
absent. Claude Frazier, a physician who was raised in the state's
southern coal camps where his father was employed as a company
doctor, wrote in Miners and Medicine that "hardy mountain
people had to rely entirely on themselves in sickness and in
health." Faced with little outside assistance, they trusted herbal
remedies administered by family members or "mountain grannies" who
were, according to Frazier, "more often than not on solid ground
with their home remedies."4

While rural West Virginians found it difficult to secure
sophisticated medical assistance before industrialization, they
sought the best health care they believed possible for themselves
and their families. Once convinced that a product or a procedure
was efficient, many embraced it enthusiastically. In the late
nineteenth century, for example, mountaineers came to share the
attachment of other Americans to patent medicines, and panaceas
like oil for earaches and salves for chest ailments became
increasingly popular in Appalachia.5

Recognizing the rising reputation of these tonics and believing
that the state was obligated to regulate such trade, West Virginia
initiated court cases against itinerant vendors who sold "dugs or
nostrums" without paying the appropriate tax. When, in 1887, J. B.
Ragland arrived in Boone County selling "Ragland's Lightening
Relief" at fifty cents per bottle, he found a receptive market. The
local sheriff, however, arrested Ragland for failing to pay "the
special tax" levied on this type of commercial activity. Ragland's
arrest and conviction eventually were upheld by the West Virginia
Court of Appeals and he was forced to pay the assessed penalties
and taxes.6

West Virginians relied on tonics, home remedies, and folk
healers because they had little familiarity with formally educated
physicians. With minimal information about scientific medicine and
limited access to trained physicians, many mountain people did not
consider medical science an option.7 In part, West Virginians
distrusted educated physicians because their state government did
not support a public institution to train medical doctors. Unlike
its neighbors, West Virginia did not establish a state-supported
medical school until well into the twentieth century. Although a
"College of Medicine" functioned at West Virginia University in
Morgantown from 1902 until 1911, it was never a fully accredited
program and did not confer its own terminal degree. The university
did not grant M.D. degrees until 1962.8

The state was also unable to provide vigorous supervision of
medical practice in the nineteenth century. Without state
supervision, legitimacy was based on personal experience and local
custom and was only occasionally authenticated by formal education
or training. Before the State Board of Health initiated formal
procedures to license physicians in the 1880s, self-proclaimed
medical practitioners often lacked even the most rudimentary
knowledge and skills. The 1870 census recorded only two
self-identified physicians in Logan County, for example, and
neither of them was literate.9 These early, sometimes poorly
trained, practitioners continued to practice after the state
government stepped in to standardize the licensing of physicians
because many of them were grandfathered into the new system.10

The lack of formal academic education does not mean that all
nineteenth-century practitioners were completely without training.
Many mountain physicians gained their education through
apprenticeships with older, experienced physicians, a standard
practice across rural America in the nineteenth century. Emmanual
Church, who practiced in McDowell County after the Civil War, was
"a typical mountaineer, uneducated--hardly able to read or write."
Church studied medicine with a Dr. Crockett in Graham, Virginia,
and received a county license to practice before the West Virginia
State Board of Health began examining prospective doctors. Hiram
Christian, who also apprenticed with Dr. Crockett, eventually set
up a medical service at Sandlick in the Tug River Valley.11 These
men certainly gained significant knowledge through their empirical
training, but the care they provided was sometimes inferior to that
offered by their better-educated colleagues. In 1881, when a
self-taught physician named Hess diagnosed smallpox as chicken pox
and failed to observe the appropriate precautions, he allowed a
deadly epidemic to spread through the villages of eastern Mercer
County and adjacent Pocahontas, Virginia.12

While rural mountain residents of pre-industrial West Virginia
did not generally enjoy the services of formally educated
physicians, their health was, in fact, remarkably well preserved by
the relatively unpolluted environment in which they resided.
According to Claude Frazier, rural West Virginians were generally
well because "they escaped many of the big epidemics of cholera and
typhoid that swept" through urban America.13 A comparison of infant
deaths in Logan County in 1872 and 1910 supports his claim. Infant
mortality from contagious diseases was actually lower before the
region was transformed by industrialization than it was almost
fifty years later.14

Involvement in the national economy through the mass production
of coal created new challenges to the well-being of the state's
citizens whose lives and health care custos were intrinsically
transformed by the industrial order. In particular, mountain
residents saw their landscapes recast as new towns were formed and
previously existing villages dramatically increased in size.15
Bluefield, for example, contained 1,775 residents in 1890, but it
grew to accommodate a citizenry of over 11,000 by 1910. Beckley
developed from a village of 158 in 1890 to a community of over
2,000 just twenty years later. Williamson and Scarbro,
unincorporated settlements in 1890, grew into towns with
populations of over 1,000 residents by 1910.16

The workers who flocked to these towns engaged in dangerous work
in the coal mines. In 1909-10, accidents killed more than one
hundred miners in McDowell County, sixty in Fayette County, and
nineteen in Raleigh County.17 Non-fatal injuries were even more
prevalent. McDowell County operations, clearly the most dangerous
in southern West Virginia, lost 246 men in non-fatal accidents,
while Fayette County followed closely with 213 during the same
period.18 To treat the injured miners and to care for their
families in the newly established coal camps, companies hired
physicians, who began to transform medical practice in the
mountains.

Company operators employed doctors because many of the coal
camps were simply too remote to attract independent physicians.
According to coal archivist Stuart McGehee, "labor was scarce, and
trained doctors were an incentive to attract good miners."19 These
physicians generally possessed more formal training than the
empirically educated practitioners who had previously provided care
to the region's inhabitants. Trained to use anaesthesia, aware of
the germ theory of disease, and possessing prophylaxis to prevent
infection, these newly arrived physicians were well equipped to
compete with the empirically trained healers who traditionally
served the region.20

When formally educated physicians entered a community,
traditional practitioners often moved to less settled areas where
the competition was not so fierce. Emmanual Church withdrew from
McDowell County when the coal companies arrived to the mountains of
Greenbrier and Pocahontas counties where he continued his practice.
Hiram Christian also left his practice when competition for
patients became too intense. Rather than relocate to a more
isolated area, he switched careers and set himself up as an
attorney in Welch. Finding the legal profession too crowded in the
McDowell County seat, he eventually moved to War, where he was the
only lawyer and became the community's justice of the peace.21

During the late nineteenth century, the numbers of educated
physicians practicing in central Appalachia increased considerably
as railroads, lumber companies, and coal mines brought in
well-trained doctors to care for employees and their families. The
increased number of physicians in the coal regions did not a
reflect a rise in the aggregate number of doctors so much as a
redistribution of physicians. Educated practitioners determined
that mining regions were potentially lucrative locations in which
to practice.

There were 1,046 licensed practitioners in West Virginia in
1890.22 By 1900, that number had risen to 1,385, and by 1910, 1,755
individuals were licensed to practice medicine in the state.23 In
relation to its population and geographical size, however, there
were relatively few physicians across the still primarily rural
state. In 1890, there was on average only one licensed doctor for
every 729 West Virginians. By 1900, that ratio had dropped to one
per 629 citizens; in 1910, it had climbed slightly so that,
theoretically, an individual physician would serve695
patients.24

The coal mining counties of southern West Virginia were
especially underserved by licensed physicians before the industrial
boom. While Fayette and Raleigh counties in 1890 boasted a
doctor-patient ratio that was only slightly higher than the state
average, few other mining counties could report the same
conditions.25 In the same year, residents would have found it
difficult to secure the services of a licensed doctor in Logan or
McDowell counties. There was only one doctor for every 1,216
residents of Logan County and one per 1,387 inhabitants in McDowell
County. Licensed physicians were true oddities in Mercer County in
1890, where the ratio was 2,000 residents per physician.26

Number of Physicians in Southern West Virginia Counties,
1881-1909

County

1881

1890

1909

Fayette

16

28

92

Logan

1

8

32*

Mercer

7

8

48

McDowell

1

6

57

Raleigh

12

11

28

*Includes physicians practicing in Mingo County, which was
formed from Logan County in 1895.27

However, southern West Virginia's coal mining regions
experienced a dramatic rise in the number of educated physicians
practicing in their communities during the years of industrial
growth. In Fayette County, for example, the doctor-patient ratio
decreased from 733 citizens per doctor in 1890 to 564 in 1910. In
McDowell County, the patients-per-doctor statistic declined
accordingly from 1,216 to 839. The most dramatic transformation of
medical service occurred in Mercer County, where an influx of new
physicians halved the patient-physician average in twenty
years.28

Many of these doctors worked for industrial concerns, but others
were private physicians drawn by the region's economic prosperity.
In the early years of the boom, however, independent physicians
were often frustrated by the opposition they met from native
people. Some locals, unwilling to pay scarce currency for services
they distrusted, remained loyal to their traditional healers. The
lack of cash also meant doctors often had to accept compensation in
produce or in manual labor. Without the financial security
guaranteed by company employment, some physicians gave up their
practices and moved from the region, as did Dr. W. R. Iaeger, the
lone physician in McDowell County before the coal boom.29

Even with the support of industrial interests, physicians faced
resistance from workers. Company employees sometimes rejected the
requirement that they contribute a portion of their salary to
retain a physician when they were not actually ill. To protest this
policy, they occasionally feigned illness in order to acquire
medicine. After securing a desired drug, one miner examined it and
declared it to be useless, protesting that the doctor offered only
"soda and flour."30

Considering the frontier-like conditions under which doctors
labored and the opposition they encountered from those they sought
to cure, it is surprising that educated doctors agreed to venture
into West Virginia's coalfields at all. Those doctors who did
hazard the coal camps undertook the mission for a variety of
reaons. For some, the mountains were home and they welcomed the
opportunity to pursue their chosen profession at a time when the
region's economy was booming and its growing population legitimized
the establishment of medical practices in rural communities.

Dr. Wade St. Clair did not venture far from home when he opened
his practice in the growing town of Bluefield in 1902. A native of
neighboring Tazewell County, Virginia, he attended the University
of Virginia's Medical College and completed postgraduate training
at New York's renowned Polytechnic Clinic. He also pursued
additional training in the hospitals of Vienna, Austria, enjoying
the benefits of an outstanding education that qualified him to set
up practice in any community in the United States. By selecting the
Bluefield area, he maintained family connections and positioned
himself to take advantage of the financial benefits offered by the
expansion of the coal economy.31

To pursue his ambitions, St. Clair joined with an outsider,
Francke Fox, to set up the Bluefield Sanitarium. Fox, who hailed
from North Carolina, was the son of a physician. A graduate of the
University of Virginia who completed his medical degree at New York
University, Fox established his first practice in Waynesboro,
Virginia, in the Shenandoah Valley. This enterprise failed to
prosper, however, and in 1892, he accepted a contract with the
Norfolk and Western Railroad to care for its employees in the
Pocahontas Coalfield.32

Fox and St. Clair combined to establish Bluefield's first
hospital in 1902, an institution that eventually developed into one
of the most modern and progressive in the region.33 When they
expanded the facility in 1914, the doctors took advantage of the
financial success achieved by St. Clair's father, a native
industrialist who had profited from the region's development.
Alexander St. Clair, who continued to reside on the family farm in
Tazewell County, became a partner in the corporation established to
fund the new facility.34 Through their partnership, St. Clair and
Fox achieved the prosperity available to those physicians, whether
local or newly arrived, who exhibited a willingness to treat
medicine as a commercial enterprise and to pursue financial success
aggressively. The Bluefield Sanitarium grew into a thriving
business that offered miners and their families unique
opportunities for medical and hospital care and illustrated the
creativity and vigor of educated physicians' new medical ideas.

St. Clair and Fox were only two of the hundreds of doctors who
set up practices in the West Virginia coalfields during the
economic upswing of the Progressive Era. An examination of the West
Virginia State Board of Health's reports demonstrates that, in
addition to the significant increase in the number of educated
physicians who settled in the state, the geographic origins and
experience of these new physicians was quite different from that of
the doctors who cared for the region's inhabitants before the coal
boom.

Prior to industrialization and the drive to professionalize
medicine, local mountaineers pursued empirical training and used
their community status to earn legitimacy as medical practitioners.
With the introduction of new professional standards, state
residents were disadvantaged by the lack of formal medical
education in the state. As professional credentials became
increasingly critical, and eventually necessary, for licensure,
West Virginians were either forced to go elsewhere for their
medical training or see medical positions within the state filled
by outsiders.35

In 1883, for example, only 6 physicians who had been educated in
Illinois were practicing in West Virginia; by 1903, that number had
increased to 304. Only 45 doctors trained in New York practiced in
West Virginia in 1883, but more than 500 of their colleagues were
licensed by the state in the succeeding twenty years.36 By 1903, in
fact, medical colleges from thirty-three states and the Dstrict of
Columbia were represented by graduates licensed to practice in West
Virginia, reflecting the national recognition of the economic
opportunity available in the coalfields.37

In spite of increased representation by physicians educated in
other regions, the doctors who set up practices in the coalfields
were most often trained in surrounding states. From July 1898 to
July 1900, nearly 50 percent of those who passed the West Virginia
licensing board graduated from schools in Maryland, Ohio, Kentucky,
or Virginia.38 Of the 141 who applied for licensure in 1902, 87
were from the neighboring states.39

Many of the physicians who moved into the coalfields were still
relatively new to the practice of medicine. Dr. J. S. Malory, an
1898 graduate of the Medical College of Virginia, opened his
practice in McDowell County in the same year he completed his
education. His classmate, Dr. A. Irvine, set up an office in 1899
in the nearby community of Bramwell, where he soon found himself
competing with Dr. W. V. Clyde, an 1899 graduate of the Maryland
Medical College. Dr. W. C. Hall, who completed his training at the
University of Virginia in 1897, opened an office in Welch in
1898.40

The careers of these young men were quite varied; some of them
spent only a few years in the area, but others committed themselves
and their families to the region. Many of the physicians who
entered the mountains as employees of coal companies moved on
rather quickly. Dr. Woods, the company doctor for the Ritter Lumber
Company, served the Dry Fork and Panther Creek regions of southern
West Virginia from 1900 until 1907. When the company completed its
cutting in the region, he departed with the rest of the workers.
Dr. Kell, an independent physician in Welch, signed on to serve as
the company physician for the Lathrop Coal Company in 1913. After
supervising the health of the residents of Lathrop's four mine
camps, Kell eventually left the area around 1926. Dr. S. D.
Hatfield, the son of feudist Anderson "Devil Anse" Hatfield, opened
a medical practice in Iaeger in 1907 and remained in the community
until 1920. He was the only physician in the area after outside
timber companies abandoned their activities, but he too soon
departed because the roads were so primitive and the people had so
little money with which to pay him.41

Hatfield's concern about financial compensation was shared by
other doctors. Traditionally, folk and herbal healers had accepted
non-cash payment for their services. Educated physicians, who
embraced the ideals of the market economy and ignored the
mountaineers' cultural practices, dismissed these traditions and
demanded that their patients recognize medical attention as a
service acquired through a cash exchange rather than barter.42

Accustomed to relating to their healers as members of their own
communities, mountain residents often failed to comprehend fully
the physicians' desire for immediate compensation. Some doctors
resorted to harsh tactics to teach patients their proper role in
the economic relationship that supported modern medicine. A
physician in southern West Virginia was called to inspect the
children of an isolated mountain family. Upon arrival, he
discovered they had been exposed to diphtheria and one of the
children was already exhibiting symptoms. The physician, who
carried with him the appropriate anti-toxin, "refused to administer
the medicine unless he was paid $60 in advance."43 In his book
Coal Towns, Crandall Shifflet related the story of a
mountain family who lost their farm to a doctor who foreclosed on
their home when they were unable to pay the $300 medical bill
accrued by a dying grandparent.44

Since medicine was frequently an uncertain enterprise, some
physicians pursued alternative or related endeavors to augment
their incomes. Like Drs. Fox and St. Clair in Bluefield, a number
of physicians opened hospitals that both supplemented their incomes
while also providing their communities with in-patient
facilities.45 Other physicians scrambled to acquire government
positions in state institutions or as county public health
administrators, a reflection of government's ncreasing reliance on
educated physicians as well as the doctors' own desire for a secure
income.46

Finally, many physicians invested in industrial enterprises. A
significant number of the investors in the Williamson-Thacker
Coalfield were physicians. An assembly that included the future
governor of West Virginia, Dr. Henry D. Hatfield, these men resided
in communities such as Bramwell and Bluefield and used their
profits as physicians to finance their business ambitions.47

Some physicians invested in industrial ventures as a way to
diversify their earnings, but the vast majority of state doctors
relied upon the revenue they generated through their professional
activities. To protect that income, educated physicians agitated
for the increased regulation of the practice of medicine and the
elevation of their professional ideals. For many, if not most,
physicians, the desire to heighten their professional status was a
complicated one founded on both philanthropic concern and economic
ambition. While they genuinely believed the care they provided was
the standard against which all others failed, they also stood to
profit by eliminating competition from traditional healers,
empirically trained physicians, and various medical sects who
gained prominence in the late nineteenth century. In order to
protect the public and to better their social and economic
conditions, West Virginia doctors followed the lead of the American
Medical Association, a professional alliance founded in New York
state in 1846, and organized coalitions to improve their status and
protect the public health by elevating their principles of practice
above traditional healers and sectarian competitors.48

The American Medical Association, and its state and local
components, was founded to protect the precepts of clinically
educated physicians who embraced allopathy, the principle that
illness must be treated by medicines or procedures intended to
terminate the symptoms of a disease. Physicians who embraced this
axiom sought to uncover treatments through medical research and
clinical inquiry and, over time, discovered the nucleus of
information that now supports contemporary medicine.49 While
allopaths were recognized as "regular" physicians who set the
standard of medical practice, they were frequently challenged in
the late nineteenth and early twentieth centuries by competitors
such as homeopaths, osteopaths, and chiropractors.50 To combat
those rivals and to elevate the principles of scientific medicine,
allopaths around the United States joined county and state
affiliates of the American Medical Association.51

West Virginia physicians formed a state medical organization in
Wheeling in 1867. The Medical Society of West Virginia was the last
state medical association to be instituted in the nation at that
time. Like their colleagues elsewhere, state physicians adopted the
American Medical Association's code of ethics and formally allied
themselves with the national association.52 As recent converts to
the drive for medical organization, state physicians were quite
vociferous in proclaiming the sanctity of their profession.
According to the booklet they published to celebrate their
society's organization, "the true physician . . . stands upon a
lofty eminence, clothed with the authority of science to interpret
nature." The author of the pamphlet proclaimed that "no calling
represents more fully or more honorably than ours, the intellectual
tendency of the times in which we live," and finally declared that
"a pervading sense of progress is everywhere at work in the medical
world."53

In spite of its declarations, West Virginia's medical society
was inferior to its neighbors both inside and outside the region.
When Dr. C. H. Maxwell, a Morgantown physician, was appointed to
represent the West Virginia society at the Pennsylvania Medical
Association's meeting in 1907, he was more than a bit chagrined by
the distinct differences he noted between his home society and that
of the Pennsylvania physicians.

According to his calculations, the Pennsylvania Medical
Association had enrolled more than 50 percent of the state's
physicians, while West Virginia had recruited only 37 percent of
those practicing within its borders. Local chapters were active in
sixty-five of Pennsylvania's sixty-seven counties, but twenty of
West Virginia's fifty-five counties contained no organized medical
association.54 These comparisons embarrassed Maxwell, who
recognized their detrimental consequences for the advancement of
allopathic ambitions in the state. Without a strong medical
association, allopathic physicians were stymied in their attempts
to regulate the practice of medicine. He asserted that the
inability of the state's physicians to seize control of the
definition and regulation of medicine had adverse consequences for
the profession as well as for the population of the state. Maxwell
warned that West Virginians had not "been trained," and that they
had not been "taught" that communicable disease was a "shame."
Having failed to "create the proper public sentiment," doctors had
not yet achieved full control of the public's expectations about
the practice of medicine.55

Maxwell's evaluation reveals that, while formally educated
physicians had acquired significant prominence in the medical
marketplace, they had not yet acquired the ability to define
medical care or to secure a monopoly over its delivery. These
ambitions had to be achieved to support their claim to sole
professional legitimacy and scientific knowledge. To that end,
doctors pursued continued patronage and support for fledgling
county medical societies and the creation of a closer alliance with
the government.

Educated, allopathic physicians needed government support
because they faced strong competition from other practitioners.
Still new to their role in the modern medical system, many citizens
persisted in their reliance upon traditional medicine as well as on
the promises of such sectarian practitioners as homeopaths and
chiropractors. Physicians looked to the government to aid them in
their battle against the popularity of these alternative sources
for health care.

Sectarian healers vehemently challenged the state association's
campaign for the passage of laws regulating medical practice. In
addition to rejecting the allopaths' insistence upon a monopoly
over legitimate medical knowledge, sectarians also disputed the
state government's right to interfere in their pursuit of a medical
career. Legal challenges to West Virginia's medical practice law
were pursued all the way to the United States Supreme Court which,
in Dent v. West Virginia, upheld the state's right to
regulate and control the practice of medicine.56

Although the Supreme Court affirmed the government's prerogative
to license medical practitioners, sectarians also challenged the
composition of the state's medical examining boards. The West
Virginia Public Health Council, also known as the Board of Public
Health, promulgated public health policy as well as examining and
licensing fledgling physicians. The multiple duties demanded of the
board were quite exhausting, but the state's recognition that
regulating the practice of medicine was a component of its mandate
to protect the public good significantly boosted allopathic
physicians. Since allopaths dominated the board, they gained
significant prestige and reinforcement for their claim that they
alone were capable of dispensing medical care. Members of the state
society actively opposed efforts to separate medical exmination
from public health supervision. They feared that defining these
duties separately would reduce allopathy to just another school of
medical practice and might proscribe their attempts to achieve a
monopoly over the public definition of legitimate medical
care.57

With the Dent decision and their ability to maintain
control over the State Board of Health, educated, allopathic
physicians celebrated a critical victory in the struggle to protect
and elevate their status. The allopaths who controlled the medical
society and the Board of Public Health were secure in their ability
to deny legitimacy to traditional and sectarian competitors. This
success, made possible by the alliance of private physicians,
organized medicine, and the government, completed the process begun
during the late nineteenth century when educated physicians began
streaming into West Virginia seeking to profit from the economic
boom.

The arrival of large-scale industrializing forces in West
Virginia in the late nineteenth century prompted a transformation
of the state's medical system. Physicians, educated in clinical
programs and trained in allopathic procedures, moved into
Appalachia as investors opened the region to development. Like many
of the capitalists who invaded the mountains seeking marketable
resources, these physicians believed that they were bringing
progress to a retarded region too long isolated from the modern
world.58

To protect their professional standards and to prevent
unqualified practitioners from preying upon the community, West
Virginia's doctors emulated their colleagues at the national level
and organized state and, eventually, local medical societies. In
the early stages, these associations were quite fragile and doctors
were challenged to recruit and maintain membership from the often
isolated physicians who served the coal camps.59

While the medical associations struggled to gain legitimacy,
doctors also reached out to form an important alliance with
government. At both local and state government levels, academically
trained physicians encouraged the state to take an active role in
the regulation of medicine. They insisted that the government
satisfy its duties as protector of the public good and prevent
substandard healers from endangering the health of the state's
citizens.

Through their association with the capitalists who acquired
control of many of the region's resources, the promotion of their
own professional societies, and their affiliation with the
government, allopaths succeeded in creating powerful networks that
elevated their professional model while denigrating other medical
philosophies. These nascent alliances did not mature until the
first decades of the twentieth century, but nineteenth-century
physicians laid important groundwork for the creation of
institutions and associations that shaped both the definition as
well as the delivery of medical care in West Virginia throughout
the twentieth century.

Notes

1. The best recent scholarship on the region has been collected
in Mary Beth Pudup, Dwight E. Billings, and Altina L. Waller,
Appalachia in the Making: The Mountain South in the Nineteenth
Century (Chapel Hill: Univ. of North Carolina Press, 1995).

2. Ronald L. Lewis, "Railroads, Deforestation, and the
Transformation of Agriculture in the West Virginia Back Counties,
1880-1920," in ibid., 303.

3. John Hennen, The Americanization of West Virginia
(Lexington: Univ. Press of Kentucky, 1996).

21. "The Early Physicians of the Sandy River District," Frazier
Coll., ERCA.

22. Department of the Interior, Census Office, Report on
Population of the United States at the Eleventh Census: 1890,
vol. 2, pt. 2 (Washington, D.C.: GPO, 1897), 337, hereafter
referred to as 1890 Census.

49. Ronald L. Numbers and John Harley Warner, "The Maturation of
American Medical Science," in Sickness and Health in America:
Readings in the History of Medicine and Public Health, ed. by
Judith Walzer Leavitt and Ronald L. Numbers (Madison: Univ. of
Wisconsin Press, 1985), 116-17.

50. Homeopaths, building on the teachings of German doctor
Samuel Hahnemann, insisted that sickness could be cured by the
administration of minute quantities of substances that actually
provoked the offensive symptom from the patient. "Like cures like,"
a phrase often used to describe homeopathic medicine, reflected the
belief that the body would heal itself if forced to respond to
external stimuli. Chiropractors and their osteopathic predecessors
insisted that illness rested in the maladjustment of bones and
relied on manual alignment to remedy disease. Charles Rosenberg,
"The Therapeutic Revolution: Medicine, Meaning, and Social Change
in 19th Century America," in Sickness and Health in America,
100; Martin Kaufman, Homeopathy in America: The Rise and Fall of
a Medical Heresy (Baltimore: Johns Hopkins Univ. Press, 1971),
7; and Norman Gevitz, The D. O.s: Osteopathic Medicine in
America (Baltimore: Johns Hopkins Univ. Press, 1982), 12.

52. Transactions of the Medical Society of the State of West
Virginia, Instituted April 10, 1867, Together with the Code of
Ethics, Constitutions, and Bylaws (Wheeling: Frew, Hagans, and
Hall, 1868), 8-9.